|
HC TRMT DEVICE - C
|
Facility
|
OP
|
$931.26
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$838.13 |
| Rate for Payer: Aetna Commercial |
$791.57
|
| Rate for Payer: Aetna Commercial |
$595.85
|
| Rate for Payer: Aetna Medicare |
$182.26
|
| Rate for Payer: Aetna Medicare |
$242.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$291.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$291.02
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS MAPPO |
$232.82
|
| Rate for Payer: BCBS MAPPO |
$175.25
|
| Rate for Payer: BCBS Trust/PPO |
$545.03
|
| Rate for Payer: BCBS Trust/PPO |
$724.05
|
| Rate for Payer: BCN Commercial |
$545.03
|
| Rate for Payer: BCN Commercial |
$724.05
|
| Rate for Payer: BCN Medicare Advantage |
$175.25
|
| Rate for Payer: BCN Medicare Advantage |
$232.82
|
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Cash Price |
$745.01
|
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Cash Price |
$745.01
|
| Rate for Payer: Cofinity Commercial |
$800.88
|
| Rate for Payer: Cofinity Commercial |
$602.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.82
|
| Rate for Payer: Healthscope Commercial |
$838.13
|
| Rate for Payer: Healthscope Commercial |
$630.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.44
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$244.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$791.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.85
|
| Rate for Payer: PACE Senior Care Partners |
$166.49
|
| Rate for Payer: PACE Senior Care Partners |
$221.17
|
| Rate for Payer: PACE SWMI |
$232.82
|
| Rate for Payer: PACE SWMI |
$175.25
|
| Rate for Payer: PHP Commercial |
$791.57
|
| Rate for Payer: PHP Commercial |
$595.85
|
| Rate for Payer: PHP Medicare Advantage |
$175.25
|
| Rate for Payer: PHP Medicare Advantage |
$232.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$810.20
|
| Rate for Payer: Priority Health Medicare |
$175.25
|
| Rate for Payer: Priority Health Medicare |
$232.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$567.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.54
|
| Rate for Payer: Railroad Medicare Medicare |
$232.82
|
| Rate for Payer: Railroad Medicare Medicare |
$175.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.51
|
| Rate for Payer: UHC Core |
$585.34
|
| Rate for Payer: UHC Core |
$777.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.82
|
| Rate for Payer: UHC Medicare Advantage |
$239.80
|
| Rate for Payer: UHC Medicare Advantage |
$180.51
|
| Rate for Payer: VA VA |
$175.25
|
| Rate for Payer: VA VA |
$232.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.44
|
|
|
HC TRMT DEVICE - C
|
Facility
|
IP
|
$931.26
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$567.98 |
| Max. Negotiated Rate |
$838.13 |
| Rate for Payer: Aetna Commercial |
$791.57
|
| Rate for Payer: Aetna Commercial |
$595.85
|
| Rate for Payer: BCBS Trust/PPO |
$541.73
|
| Rate for Payer: BCBS Trust/PPO |
$719.68
|
| Rate for Payer: BCN Commercial |
$719.68
|
| Rate for Payer: BCN Commercial |
$541.73
|
| Rate for Payer: Cash Price |
$745.01
|
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Cofinity Commercial |
$800.88
|
| Rate for Payer: Cofinity Commercial |
$602.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.01
|
| Rate for Payer: Healthscope Commercial |
$630.90
|
| Rate for Payer: Healthscope Commercial |
$838.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$791.57
|
| Rate for Payer: PHP Commercial |
$595.85
|
| Rate for Payer: PHP Commercial |
$791.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$810.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$567.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.88
|
| Rate for Payer: UHC Core |
$585.34
|
| Rate for Payer: UHC Core |
$777.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.44
|
|
|
HC TROFILE
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
30600179
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,225.90 |
| Max. Negotiated Rate |
$1,809.00 |
| Rate for Payer: Aetna Commercial |
$1,708.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.33
|
| Rate for Payer: BCN Commercial |
$1,553.33
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cofinity Commercial |
$1,728.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,608.00
|
| Rate for Payer: Healthscope Commercial |
$1,809.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,507.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,708.50
|
| Rate for Payer: PHP Commercial |
$1,708.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,748.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,225.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,768.80
|
| Rate for Payer: UHC Core |
$1,678.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,507.50
|
|
|
HC TROFILE
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
30600179
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$477.38 |
| Max. Negotiated Rate |
$1,809.00 |
| Rate for Payer: Aetna Commercial |
$1,708.50
|
| Rate for Payer: Aetna Medicare |
$522.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$628.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$628.12
|
| Rate for Payer: BCBS Complete |
$804.00
|
| Rate for Payer: BCBS MAPPO |
$502.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.78
|
| Rate for Payer: BCN Commercial |
$1,562.78
|
| Rate for Payer: BCN Medicare Advantage |
$502.50
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cofinity Commercial |
$1,728.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,608.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.50
|
| Rate for Payer: Healthscope Commercial |
$1,809.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,507.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$527.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$577.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,708.50
|
| Rate for Payer: PACE Senior Care Partners |
$477.38
|
| Rate for Payer: PACE SWMI |
$502.50
|
| Rate for Payer: PHP Commercial |
$1,708.50
|
| Rate for Payer: PHP Medicare Advantage |
$502.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,748.70
|
| Rate for Payer: Priority Health Medicare |
$502.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,225.90
|
| Rate for Payer: Railroad Medicare Medicare |
$502.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,768.80
|
| Rate for Payer: UHC Core |
$1,678.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.50
|
| Rate for Payer: UHC Medicare Advantage |
$517.58
|
| Rate for Payer: VA VA |
$502.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,507.50
|
|
|
HC TROPONIN QUANTITATIVE
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
30100449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$27.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.94
|
| Rate for Payer: BCBS Complete |
$9.66
|
| Rate for Payer: BCBS MAPPO |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$81.95
|
| Rate for Payer: BCN Commercial |
$81.95
|
| Rate for Payer: BCN Medicare Advantage |
$26.35
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.35
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Mclaren Medicaid |
$9.20
|
| Rate for Payer: Meridian Medicaid |
$9.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Senior Care Partners |
$25.03
|
| Rate for Payer: PACE SWMI |
$26.35
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$26.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Medicare |
$26.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: Railroad Medicare Medicare |
$26.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.35
|
| Rate for Payer: UHC Medicare Advantage |
$27.14
|
| Rate for Payer: VA VA |
$26.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC TROPONIN QUANTITATIVE
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
30100449
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: BCBS Trust/PPO |
$81.45
|
| Rate for Payer: BCN Commercial |
$81.45
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC TROUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC TROUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC TRYPTASE, S
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.81 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$50.45
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC TRYPTASE, S
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.40
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$50.76
|
| Rate for Payer: BCN Commercial |
$50.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.32
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.79
|
| Rate for Payer: Priority Health Medicare |
$16.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.81
|
| Rate for Payer: Railroad Medicare Medicare |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.32
|
| Rate for Payer: UHC Medicare Advantage |
$16.81
|
| Rate for Payer: VA VA |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC TSH RECEPTOR ANTIBODIES
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.24
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC TSH RECEPTOR ANTIBODIES
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100256
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$17.07
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC TSH THYROID STIMULATING HORMONE
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
30100438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS MAPPO |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$35.69
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.48
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Mclaren Medicaid |
$12.40
|
| Rate for Payer: Meridian Medicaid |
$13.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.48
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: Railroad Medicare Medicare |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.82
|
| Rate for Payer: VA VA |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC TSH THYROID STIMULATING HORMONE
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
30100438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$35.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC TUBE CHANGE OF CYSTOSTOMY SIMPLE
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
36100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.30 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: BCBS Trust/PPO |
$304.48
|
| Rate for Payer: BCN Commercial |
$304.48
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.20
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.90
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.72
|
| Rate for Payer: UHC Core |
$328.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.50
|
|
|
HC TUBE CHANGE OF CYSTOSTOMY SIMPLE
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
36100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Aetna Commercial |
$334.90
|
| Rate for Payer: Aetna Medicare |
$102.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.12
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$98.50
|
| Rate for Payer: BCBS Trust/PPO |
$306.34
|
| Rate for Payer: BCN Commercial |
$306.34
|
| Rate for Payer: BCN Medicare Advantage |
$98.50
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$338.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.50
|
| Rate for Payer: Healthscope Commercial |
$354.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.50
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$103.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.90
|
| Rate for Payer: PACE Senior Care Partners |
$93.58
|
| Rate for Payer: PACE SWMI |
$98.50
|
| Rate for Payer: PHP Commercial |
$334.90
|
| Rate for Payer: PHP Medicare Advantage |
$98.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.78
|
| Rate for Payer: Priority Health Medicare |
$98.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.30
|
| Rate for Payer: Railroad Medicare Medicare |
$98.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.72
|
| Rate for Payer: UHC Core |
$328.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.50
|
| Rate for Payer: UHC Medicare Advantage |
$101.46
|
| Rate for Payer: VA VA |
$98.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.50
|
|
|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
IP
|
$2,033.83
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,240.43 |
| Max. Negotiated Rate |
$1,830.45 |
| Rate for Payer: Aetna Commercial |
$1,728.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,571.74
|
| Rate for Payer: BCN Commercial |
$1,571.74
|
| Rate for Payer: Cash Price |
$1,627.06
|
| Rate for Payer: Cofinity Commercial |
$1,749.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,627.06
|
| Rate for Payer: Healthscope Commercial |
$1,830.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,525.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.76
|
| Rate for Payer: PHP Commercial |
$1,728.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,769.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,240.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,789.77
|
| Rate for Payer: UHC Core |
$1,698.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,525.37
|
|
|
HC TUBE CHANGE URETERO VIA ILEALO
|
Facility
|
OP
|
$2,033.83
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
36100248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.03 |
| Max. Negotiated Rate |
$1,830.45 |
| Rate for Payer: Aetna Commercial |
$1,728.76
|
| Rate for Payer: Aetna Medicare |
$528.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$635.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$635.57
|
| Rate for Payer: BCBS Complete |
$1,402.94
|
| Rate for Payer: BCBS MAPPO |
$508.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,581.30
|
| Rate for Payer: BCN Commercial |
$1,581.30
|
| Rate for Payer: BCN Medicare Advantage |
$508.46
|
| Rate for Payer: Cash Price |
$1,627.06
|
| Rate for Payer: Cash Price |
$1,627.06
|
| Rate for Payer: Cofinity Commercial |
$1,749.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,627.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.46
|
| Rate for Payer: Healthscope Commercial |
$1,830.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,525.37
|
| Rate for Payer: Mclaren Medicaid |
$1,336.13
|
| Rate for Payer: Meridian Medicaid |
$1,402.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$533.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.76
|
| Rate for Payer: PACE Senior Care Partners |
$483.03
|
| Rate for Payer: PACE SWMI |
$508.46
|
| Rate for Payer: PHP Commercial |
$1,728.76
|
| Rate for Payer: PHP Medicare Advantage |
$508.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,336.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,769.43
|
| Rate for Payer: Priority Health Medicare |
$508.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,240.43
|
| Rate for Payer: Railroad Medicare Medicare |
$508.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,789.77
|
| Rate for Payer: UHC Core |
$1,698.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.46
|
| Rate for Payer: UHC Medicare Advantage |
$523.71
|
| Rate for Payer: VA VA |
$508.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,525.37
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
OP
|
$214.77
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.01 |
| Max. Negotiated Rate |
$193.29 |
| Rate for Payer: Aetna Commercial |
$182.55
|
| Rate for Payer: Aetna Medicare |
$55.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.12
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$53.69
|
| Rate for Payer: BCBS Trust/PPO |
$166.98
|
| Rate for Payer: BCN Commercial |
$166.98
|
| Rate for Payer: BCN Medicare Advantage |
$53.69
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cofinity Commercial |
$184.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.69
|
| Rate for Payer: Healthscope Commercial |
$193.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.08
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.55
|
| Rate for Payer: PACE Senior Care Partners |
$51.01
|
| Rate for Payer: PACE SWMI |
$53.69
|
| Rate for Payer: PHP Commercial |
$182.55
|
| Rate for Payer: PHP Medicare Advantage |
$53.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.85
|
| Rate for Payer: Priority Health Medicare |
$53.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.99
|
| Rate for Payer: Railroad Medicare Medicare |
$53.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.00
|
| Rate for Payer: UHC Core |
$179.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.69
|
| Rate for Payer: UHC Medicare Advantage |
$55.30
|
| Rate for Payer: VA VA |
$53.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.08
|
|
|
HC TUBE CHECK WITH FLUORO
|
Facility
|
IP
|
$214.77
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
36100233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.99 |
| Max. Negotiated Rate |
$193.29 |
| Rate for Payer: Aetna Commercial |
$182.55
|
| Rate for Payer: BCBS Trust/PPO |
$165.97
|
| Rate for Payer: BCN Commercial |
$165.97
|
| Rate for Payer: Cash Price |
$171.82
|
| Rate for Payer: Cofinity Commercial |
$184.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.82
|
| Rate for Payer: Healthscope Commercial |
$193.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.55
|
| Rate for Payer: PHP Commercial |
$182.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.00
|
| Rate for Payer: UHC Core |
$179.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.08
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
IP
|
$471.44
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.53 |
| Max. Negotiated Rate |
$424.30 |
| Rate for Payer: Aetna Commercial |
$400.72
|
| Rate for Payer: BCBS Trust/PPO |
$364.33
|
| Rate for Payer: BCN Commercial |
$364.33
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cofinity Commercial |
$405.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.15
|
| Rate for Payer: Healthscope Commercial |
$424.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.72
|
| Rate for Payer: PHP Commercial |
$400.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.87
|
| Rate for Payer: UHC Core |
$393.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.58
|
|
|
HC TUBE PLACEMENT NASOG OR OROG W FLUO
|
Facility
|
OP
|
$471.44
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
36100191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.97 |
| Max. Negotiated Rate |
$424.30 |
| Rate for Payer: Aetna Commercial |
$400.72
|
| Rate for Payer: Aetna Medicare |
$122.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.32
|
| Rate for Payer: BCBS Complete |
$274.44
|
| Rate for Payer: BCBS MAPPO |
$117.86
|
| Rate for Payer: BCBS Trust/PPO |
$366.54
|
| Rate for Payer: BCN Commercial |
$366.54
|
| Rate for Payer: BCN Medicare Advantage |
$117.86
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cash Price |
$377.15
|
| Rate for Payer: Cofinity Commercial |
$405.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.86
|
| Rate for Payer: Healthscope Commercial |
$424.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.58
|
| Rate for Payer: Mclaren Medicaid |
$261.37
|
| Rate for Payer: Meridian Medicaid |
$274.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.72
|
| Rate for Payer: PACE Senior Care Partners |
$111.97
|
| Rate for Payer: PACE SWMI |
$117.86
|
| Rate for Payer: PHP Commercial |
$400.72
|
| Rate for Payer: PHP Medicare Advantage |
$117.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.15
|
| Rate for Payer: Priority Health Medicare |
$117.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.53
|
| Rate for Payer: Railroad Medicare Medicare |
$117.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.87
|
| Rate for Payer: UHC Core |
$393.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.86
|
| Rate for Payer: UHC Medicare Advantage |
$121.40
|
| Rate for Payer: VA VA |
$117.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.58
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
IP
|
$303.31
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.99 |
| Max. Negotiated Rate |
$272.98 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: BCBS Trust/PPO |
$234.40
|
| Rate for Payer: BCN Commercial |
$234.40
|
| Rate for Payer: Cash Price |
$242.65
|
| Rate for Payer: Cofinity Commercial |
$260.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.65
|
| Rate for Payer: Healthscope Commercial |
$272.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.81
|
| Rate for Payer: PHP Commercial |
$257.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.91
|
| Rate for Payer: UHC Core |
$253.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.48
|
|
|
HC TUBE REPLACEMENT BY PHYSICIAN
|
Facility
|
OP
|
$303.31
|
|
| Hospital Charge Code |
45000055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$272.98 |
| Rate for Payer: Aetna Commercial |
$257.81
|
| Rate for Payer: Aetna Medicare |
$78.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.78
|
| Rate for Payer: BCBS Complete |
$121.32
|
| Rate for Payer: BCBS MAPPO |
$75.83
|
| Rate for Payer: BCBS Trust/PPO |
$235.82
|
| Rate for Payer: BCN Commercial |
$235.82
|
| Rate for Payer: BCN Medicare Advantage |
$75.83
|
| Rate for Payer: Cash Price |
$242.65
|
| Rate for Payer: Cofinity Commercial |
$260.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.83
|
| Rate for Payer: Healthscope Commercial |
$272.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.81
|
| Rate for Payer: PACE Senior Care Partners |
$72.04
|
| Rate for Payer: PACE SWMI |
$75.83
|
| Rate for Payer: PHP Commercial |
$257.81
|
| Rate for Payer: PHP Medicare Advantage |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.88
|
| Rate for Payer: Priority Health Medicare |
$75.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.99
|
| Rate for Payer: Railroad Medicare Medicare |
$75.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.91
|
| Rate for Payer: UHC Core |
$253.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.83
|
| Rate for Payer: UHC Medicare Advantage |
$78.10
|
| Rate for Payer: VA VA |
$75.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.48
|
|
|
HC TUBING 1/2
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
27000663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$13.91
|
| Rate for Payer: BCN Commercial |
$13.91
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.40
|
| Rate for Payer: Healthscope Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.30
|
| Rate for Payer: PHP Commercial |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.84
|
| Rate for Payer: UHC Core |
$15.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.50
|
|
